How Much Does Infusion Therapy Cost?

When you receive a chronic disease diagnosis, there is a whirlwind of thoughts and questions that come to mind. Though discussing treatment options is usually the top priority, the next question is often, “How much does infusion therapy cost?”

How Much Does Infusion Therapy Cost?

While infusion therapy can be an extremely effective way to treat chronic diseases, it often comes with a high price tag due to the extensive research behind the development of these medications. Depending on the medication type and dosage, the cost of infusion therapy can range from $200 to $1,000 or more per treatment, with many patients needing multiple weekly or monthly treatments.

For perspective, a year of infusion therapy treatment can cost anywhere from a few thousand to tens of thousands of dollars. According to an analysis of rheumatoid arthritis patients, the estimated cost of RA infusion therapy per year in a hospital setting is between $36,000 and $47,000.

In addition to the manufacturer’s cost of the infusible drugs and biologics, there’s also a cost for the equipment and medical staff necessary for an infusion facility to administer the medication. Infusion costs also differ depending on the drug, infusion location, dosage, and more. These costs are passed down to insurance companies, and the uncovered remainder will become the patient’s responsibility.

Insurance Coverage for Infusion Therapy

When your insurance is considering your coverage for infusion treatments, there are two important elements they will review:

  1. The therapy, which is the process of administering the medication
  2. The medication, which is the drug prescribed to be infused

You will need a prescription from your physician before your insurance can determine coverage. Usually, insurance companies will not cover infusion therapy unless it is for a chronic illness. This may require clinical notes from your physician to support your need for the medication.

The majority of FlexCare’s patients receive some degree of insurance approval for infusion therapy because our team provides documentation that supports the need for medication. If your insurance company deems infusion therapy is not medically necessary for your treatment plan, our team may be able to work with your physician to appeal their decision.

How to Save on the Cost of Infusion Therapy

In the event your insurance company refuses to cover the cost of infusion therapy, or if you still have high out-of-pocket costs after coverage, you may be eligible for other cost-saving opportunities.

If you are looking to lower your out-of-pocket cost for infusion therapy, here are 6 ways you may be able to save.

Biologics vs Biosimilars

The difference between biologics and biosimilar drugs is minuscule. In fact, there are no clinically significant differences between biologic and biosimilar infusible medications. And in the case of interchangeable biosimilars, which go through additional testing requirements, they are interchangeable with biologics. However, unlike biologic medications, biosimilars don’t take as long to initially produce since clinical trials have already been completed on the biologics. As a result, biosimilars are generally less expensive.

For instance, Remicade® (Infliximab) is a biologic used to treat patients with Crohn’s disease, ulcerative colitis, rheumatoid and psoriatic arthritis, plaque psoriasis, and ankylosing spondylitis. Many patients with these diagnoses receive infusible biosimilars (Renflexis, Inflectra, Avsola) with comparable results.

Talk with your doctor about biosimilars as an alternative to a biologic. Depending on the drug, the cost of infusion therapy biosimilars can be around 15 to 35% less expensive than their parent biologic. Keep in mind that availability, location, insurance coverage, and your diagnosis can affect whether you are able to receive a biosimilar over a biologic.

If you have questions about your prescribed biologic, reach out to your provider.

Co-pay and Drug Assistance Programs

Participation in a co-pay or drug assistance program can save you money on out-of-pocket infusion costs. These programs are often offered through drug manufacturers, disease foundations, or other independent entities. When you use a co-pay or drug assistance card, your insurance company and medication manufacturer will pay for some or all of the co-pay.

For instance, depending on your eligibility, you may be able to pay as little as $0 per dose of KRYSTEXXA® as a member of the Horizon Commercial Co-pay Program.

These programs are often available for biologic medications that don’t have biosimilar alternatives. Visit your medications manufacturer’s website to find more information on programs and eligibility.

Disease foundations also may offer drug assistance programs and a directory of disease or drug-specific financial resources, including independent funds and financial support options. For example, The Lupus Foundation of America, Crohn’s and Colitis Foundation, and the National MS Society all provide financial resources for patients seeking fiscal support.

Remember to review the eligibility criteria before applying to a program.

Your infusion center may also offer co-pay assistance support to help cover the cost of infusion therapy. FlexCare Infusion Centers offers a Co-pay assistance program to patients who need extra support affording infusion therapy treatments. To learn more, give us a call at (405) 509-6599 or send us a message.

Site of Care Matters

Did you know that the location you receive your infusion could cost you more? Inpatient or hospital infusion centers are often more costly to patients (up to 3 to 5 times) than ambulatory (stand-alone) centers or home infusions.

According to the National Infusion Center Association, optimizing the patients’ site of care can dramatically lower costs. For example, in Magellan’s 2017 Medical Pharmacy Trend Report, hospital treatments for Remicade (infliximab) were more than double the cost of an ambulatory clinic. The savings can be even greater depending on the medication.

It’s important to discuss the site of care with your provider before receiving treatment. Your provider may be able to send your referral to a stand-alone center, like FlexCare. Our private infusion suites are designed with patient comfort in mind and include leather recliners, free Wi-Fi, and complimentary snacks and drinks. Ask your provider to send your referral to FlexCare Infusion Centers.

Make Sure You are In-Network

In-network providers or services will save you money on the cost of infusion therapy. That’s because an in-network provider or service is contracted with your insurance provider and can charge you less for care.

Patients can still receive care from out-of-network providers, but may have to pay full price—the cost difference can be significant.

Your health plan matters too: patients with an HMO plan (Health Maintenance Organization) typically won’t have any benefits with providers that are out-of-network. Patients with a PPO (Preferred Provider Organization) usually will have benefits with out-of-network providers, however, costs may still be higher than if they received care from an in-network provider.

Double-check that your insurance plan is in-network with your infusion clinic. FlexCare Infusion Centers is in-network with most major insurance plans, including BlueCross BlueShield, Cigna, and others.

Consider an FSA or HSA

Some employers offer Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to help their employees pay for medical costs, including the cost of infusion therapy. FSAs are only offered through your employer, but you may be able to open an HSA on your own depending on your health plan.

Both plans allow you to put away pre-tax dollars that are also tax-free when withdrawn. HSA contributions grow over time and can be rolled over year-to-year, but FSA dollars don’t roll over year-to-year. It’s important to plan your expenses accordingly to use funds appropriately.

Discuss Your Financial Concerns with Your Provider

Navigating a new diagnosis can be stressful, and the last thing patients want to worry about is how they will be able to afford their medication. If you are concerned about the cost of infusion therapy, talk with your referring provider. They may be able to offer or suggest additional resources.

Do you have questions about financial assistance for infusion therapy? Our team at FlexCare Infusion Centers helps patients afford their medications. Contact a member of our team to learn more about your eligibility for financial assistance programs.

 

Updated April 13, 2023

Makenna joined FlexCare in 2021 as the Managing Nurse Practitioner in Birmingham. In 2023, she assumed the role of National Director of Clinical Services. Makenna oversees protocol optimization, patient safety, and clinical procedures.

Makenna holds an MSN and FNP-C certification from Samford University. Previously, Makenna worked as an ENT nurse before earning her certification from the American Academy of Nurse Practitioners (AANP) in 2018.

Makenna is married to Wes, and together they have two cats, Ralphie and Beans. She enjoys going to concerts, trying new restaurants, playing trivia and board games with friends, and has recently taken up skateboarding as a hobby.

Heather joined FlexCare in 2020 and led the development of the Intake team before taking over Revenue Cycle Management in 2022. Heather has 10 years of medical RCM experience in ambulatory, specialty pharmacy, and home infusion. Previously, Heather was the Assistance Director of RCM in Intake for a Specialty Pharmacy and Home Infusion service in Kansas. 

Currently, Heather oversees RCM for FlexCare’s ambulatory infusion services and specialty pharmacy. She lives in Olathe, KS with her husband and two children.

Rebekkah joined FlexCare Infusion Centers in 2019 as a Managing Nurse Practitioner and Specialty Biologics Clinical Reviewer before assuming the role of Director of Patient Access in 2022. Rebekkah heads FlexCare’s industry-leading Intake team and ensures FlexCare patients experience the shortest time to treatment.

Rebekkah graduated from the University of Oklahoma Health Sciences Center where she earned her Master of Science Degree in Nursing with a Family Nurse Practitioner emphasis. She has over 16 years of experience in patient care and is passionate about infusion therapy and best serving our patients.

Rebekkah lives in Oklahoma City with her 3 kids and her dog. When she’s not keeping busy with her kids, you can find her in her craft room.

Matt is an acute care Nurse Practitioner with over a decade of committed service to the patients in his community. Matt joined FlexCare in 2021 as a Managing Nurse Practitioner and led the launch of the first FlexCare location in Alabama before assuming the role of Vice President of Operations in 2023.

Matt received his BSN from Auburn University before earning his MSN from Vanderbilt University. His experience includes Intensive Care, Transplant Medicine, Cardiothoracic Surgery, and Outpatient Care. Prior to joining FlexCare, Matt developed and launched two new service lines for an outpatient cardiology group in Alabama.

Matt and his wife Rachel reside in Birmingham, AL with their two pets, Addie and Jenkins.

Austin joined FlexCare in 2020 as a software consultant before assuming the role of Vice President of Technology in 2021. He led the initiative to build a custom-developed enterprise software solution that supports and enhances FlexCare’s vital Intake team, and later led the projects to create data and reporting systems to support all departments. He oversees FlexCare’s software, data, IT, and communications projects.

Austin graduated from the University of Oklahoma with a degree in mechanical engineering. His focus on electromechanical systems quickly led to a passion for automation and building software and data solutions. After gaining experience as a software and applications engineer, he started a software consulting company and has launched several enterprise web, desktop, and mobile applications.

Austin lives in Oklahoma City with his wife, Skye, and two kids. In his free time, you can find him on the running trail, golf course, or playing games and sports with his family and friends.

Rick’s professional trajectory took him into leadership just 3 years after obtaining his Doctor of Pharmacy (Pharm.D.) from the University of Arizona. His desire to be a business leader in the world of pharmaceuticals and operations drove him to complete two post-graduate residencies in Milwaukee, WI, with a heavy concentration on administration leadership.  Rick was selected to represent the state of Wisconsin in a joint venture with the state of Iowa at the 2007 Young Pharmacy Leaders Conference.  

After a successful launch to his career in Milwaukee, WI, Rick returned to Arizona to be closer to his extended family.  In Arizona, he oversaw all pharmaceutical operations of the hospital-based outpatient clinics at HonorHealth, where he met his future business partner, Mark Kharoufeh.  Rick and Mark co-founded InfuseAble Care in Scottsdale, AZ, in 2020.  When FlexCare acquired InfuseAble Care in 2021, Rick transitioned to EVP of Pharmacy, leading the supply chain and procurement initiatives across the enterprise.  With the recent acquisition of a specialty pharmacy, Rick extended his purview to include oversight of this valuable service line.

Rick currently resides in Scottsdale, AZ with his wife.  His son attends Northern Arizona University in Flagstaff, AZ.

Mark began his journey in healthcare almost 30 years ago as a pediatric oncology nurse at Los Angeles Children’s Hospital. His evolution in healthcare through various clinical, leadership, and executive roles and a passion for customer service led him down a successful path of business operations. In 2012, Mark was a finalist for AZ Business Magazine’s “Healthcare Professional of the Year” for his leadership in an all-inclusive care under one roof ambulatory healthcare service model. Mark obtained his MBA from Grand Canyon University in 2015 and completed the University of Arizona Eller Executive Leadership Program in 2019. 

Mark’s dedication to enhancing access to healthcare and a model that always places the patients and their caregivers at the center of every visit was the impetus for teaming up with Rick Yerondopoulos and establishing InfuseAble Care in November 2020. Through Mark and Rick’s reputation in Arizona for reliable and service-oriented healthcare, InfuseAble Care’s brand quickly became the trusted ambulatory infusion center for physicians to refer their patients to around the state. Mark and Ricks’s goals of scaling InfuseAble Care nationally came to fruition upon meeting Aaron Smith, Callie Turk, and Adam Midkiff of FlexCare and RC Capital and ultimately joined FlexCare Infusion via acquisition in December 2021.

Since uniting with FlexCare to provide a reimagined infusion experience across the country, FlexCare has grown to 30 ambulatory centers across three states.

Mark currently resides in Litchfield Park, AZ with his wife, two sons, daughter, and labradoodle Eevee. 

Adam joined FlexCare in 2023, though he has been involved with the organization from the early stages. He is excited by FlexCare’s mission to provide better access and high-quality care to patients in cost appropriate settings. Prior to joining FlexCare, Adam was a private equity investor with RC Capital, and he helped architect the partnership between FlexCare and RC. Prior to Adam’s experience in healthcare private equity, he was an investment banker in New York City and involved in numerous M&A and capital raising transactions.

Adam currently resides in Cincinnati, OH with his wife and two kids. He serves on the board of the Cincinnati Healthcare Professionals Network, a group of healthcare leaders with a common goal to advance healthcare innovation within the Cincinnati ecosystem. He graduated from the University of Kentucky with a degree in finance. In his spare time, Adam can be found on a soccer field or a golf course.

Jack joined FlexCare in 2023, after most recently serving as CFO and COO of Lighthouse Behavioral Health Solutions in Central Ohio. Lighthouse focuses on improving the lives of those suffering from substance abuse disorder by combining a suite of services in an outpatient setting along with recovery housing. Prior to Lighthouse, Jack had stints in corporate accounting and finance roles at PricewaterhouseCoopers, Omnicare, and Procter & Gamble. Additionally, he embarked on an entrepreneurial journey over the last decade, beginning with a hospitality business that has grown from a single, urban sports bar to 8 bar, restaurant, and brewery locations opened in 10 years. He also opened and sold a boutique fitness studio.

Jack graduated from Miami University with bachelor’s and master’s degrees in accounting. He resides in Cincinnati, OH, where he can often be found on the golf course or trying to stay active by chasing around his young kids with his wife, Anna.